In many areas of Western medicine, rigorously controlled research and carefully documented experience allow fairly definitive answers to questions of diagnosis and treatment of any given malady. Although the quality of research in acupuncture is now better meeting the requirements of Western medicine, we still can rarely answer questions based on a Western scientific-evidence-based model. The reasons for which lie in the nature of the two systems themselves. Nature does not reveal itself to us, but only gives answers to the questions that we pose. In November of 1997 the National Institutes of Health (NIH) convened a conference on acupuncture to determine what answers we do have from a rigorous scientific standpoint.
Read the Consensus Statement on Acupuncture
The distinct methods used by oriental medicine have long posed problems of understanding and accreditation for Western practitioners seeking to verify the efficacy of acupuncture. Western allopathic medicine treats diagnoses, and diagnoses are often established by fairly objective impersonal standards. The conventional Western medical model, by treating specific and "objective" diagnoses, can easily design studies which permit statistical inferences about the benefits of an intervention.
This approach is in contrast to traditional acupuncture models where an individual, not a diagnosis, is treated. Treatment is based not only on diagnostic evaluations derived fromsubjective signs and symptoms but on an accurate assessment of a patients nature/constitution. In a medical model such as traditional oriental medicine,where optimal treatment requires individualization, Western statistical analyses and study design must challenge a sole reliance on "standard" approaches to be meaningful.
Therein lies the problem. It is human nature to want the best medical care according to established standards, which in this country are based on the traditional scientific model.Average Westerners, having been exposed to a fairly homogeneous group of medical practitioners, tend to assume that there is an optimal treatment regimen for any given condition. Since most medical doctors will ask similar questions, do similar exams, order similar tests and recommend similar therapies for a given problemtheir approach being based on similar research, teaching and experiencepeople assume that a physician who deviates from the norm is either ignorant or incompetent. (The exception would be physicians exploring new treatment regimes in research settings.)
There have been attempts to "standardize" acupuncture approaches. The Chinese government under communist rule has created a model of acupuncture called Traditional Chinese Medicine. This is the model taught in most acupuncture schools in the West. Although based on traditional models of oriental medicine, particularly herbal approaches, it only partially reflects the wealth of acupuncture models used historically and today.
For those interested in studying the history of acupuncture, I recommend the book:
- In the Footsteps of the Yellow Emperor
by Peter Eckman, M.D.
Cypress Book Co. 1996
3450 Third Street, Unit 4B
San Francisco, CA 94124
The Yellow Emperor and other recent studies of acupuncture make it evident that the world of oriental medicine is much more diversified than the world of western medicine. There are different schools of acupuncture with significantly different approaches to patients.
Some practitioners approach patients from a standard medical perspective: What's the diagnosis? Here's the treatment.Others are clearly more interested in exploring the implications of a symptom/condition in order to improve not only present, but future health as well.Recently, I heard a well-published acupuncturist state that he wasn't so concerned whether a terminally ill patient died if he was able to help the patient obtain self actualization prior to death as a result of the acupuncture treatment.
The diversity of approaches and the nature of the practice of medicine often cause some practitioners to hold strong opinions about how a patient should or should not be treated.And there even remains, understandably, quite a bit of controversy about who is qualified to practice acupuncture. Here political, legal, and financial pressures enter into the picture, further complicating and clouding our understanding of oriental medicine.
As a result of all of the above limitations on our knowledge of acupuncture, you might find the answers to some of your questions somewhat vague. The answers you will find here are from physicians experienced in several "approaches" to acupuncture and desirous for their patients to benefit from the best of all effective treatments medicine can offer. Our intention is to be not dogmatic, given our awareness of how little we know in this exciting and promising specialty of medicine, but to provide some introductory guidance and offer alternatives to those seeking help for conditions that conventional Western medicine has not been able to treat with great success in individual cases.
James K. Rotchford, M.D., M.P.H